Wednesday, September 30, 2009

The Resilient Public Option . . .

Is the public option really dead yet? At the point, it's anyone's guess.

I obviously spoke too soon last time . . .

But I'm still betting that the public option will be excluded from the final version of the bill.

Any takers?


Greg Mankiw tears into President Obama for his health care hypocrisy.

I suppose that while the president is apologizing to John McCain for attacking McCain's proposal to tax employer-provided health insurance, he should also apologize to Hillary Clinton for criticizing Clinton's proposal to mandate health coverage . . . .

Monday, September 28, 2009

Health Care Racism

Ryan Sager offers this assessment of the correlation between racial resentment and opposition to health care reform:

Whites in the South are the most anti-black group in America; a lot more whites in the South are now Republicans than were at the beginning of the 1990s.

What this all adds up to is that both of these statements can be true at the same time:

1) Many of Obama’s opponents harbor a significant amount of racial resentment against black people.

2) To quote Bill Clinton: “100% of those who are opposing him now would be against him if he were a white Democrat.”

Opposition to Obama is tied up with race because party identification in America is tied up with race. Are there some racist idiots at many of the GOP rallies? Yes. Would there be sexist idiots if Hillary Clinton were president? Also yes. Would any Democratic president be able to reform the entire health-care system — or undertake any major government-growing reform — without significant opposition from roughly the same group of people who are out protesting today? Absolutely not.

I think he's is right. But Sager also believes that a "very large chunk of the people predisposed to oppose Obama’s policies are also racists." As evidence he links to this WaPo "study," which I find extremely unconvincing:

As evidence of the link between health care and racial attitudes, we analyzed survey data gathered in late 2008. The survey asked people whether they favored a government run health insurance plan, a system like we have now, or something in between. It also asked four questions about how people feel about blacks.

Taken together the four items form a measure of what scholars call racial resentment. We find an extraordinarily strong correlation between racial resentment of blacks and opposition to health care reform.

Among whites with above average racial resentment, only 19 percent favored fundamental health care reforms and 57 percent favored the present system. Among those who have below average racial resentment, more than twice as many (45 percent) favored government run health care and less than half as many (25 percent) favored the status quo.

What survey data did they use? How large was the sample? How many respondents identified themselves as Republican? What was the survey's margin of error? What were the four questions that were used as a proxy for "racial resentment"? Were these questions designed to "coax" people into revealing their true racial sentiments? Were the questions open-ended? Were they ranked on an ordinal scale? How was the data coded? How strong was the correlation?

The authors don't reveal the answers to any of these questions.

Could their numbers be accurate? Maybe. But how can we assess the validity of this study if they have failed to provide even the most basic level of transparency?

Sunday, September 27, 2009

Equal Bodies

My friend recalls an old conversation in which I argued for a more gender-balanced view of sexual objectification. She writes:

. . . men and women aren't treated equally, aren't seen as equals, aren't valued in the same ways in the same spaces. And yes, men shouldn't be reduced to muscular arms and flat, tan stomachs and shouldn't begin to enter the world of debasement women have been living in for such a long time, that reaching equality at the lowest common denominator is no way to reach equality. [But] men - white men, I should specify - are still generally seen first and foremost as people. Therefore, being reduced to an object is still a terrible thing, but its cultural impact is not the same if the same image is with a woman. Because, as much as I wish all things were equal, women are still primarily seen as bodies first. [my emphasis]

I'm not sure how to even begin unpacking this last sentence.

By whom are women "primarily seen as bodies" rather than people? Men? Society? The dominant culture? I think my friend may be lumping these three together.

Is it really so easy to pin down the dominant strands of contemporary American thought amidst such vast ideological diversity? Can we really paint with such broad strokes? Is power really so highly concentrated in today's pluralistic society?

As a policy person, I may approach these questions from a slightly different perspective. To me, power is the ability to place things onto the political decision agenda or to keep them off of that agenda. In both respects, women's organizations have been immensely powerful over the past several decades. And I think this may be part of the reason why I am unwilling to accept such a generalized conception of how women are "seen" in America.

This model of society -- a culture that is so fundamentally repressive toward women -- fails to incorporate the past 40 years of social progress, and the incredible political clout that women's organizations now wield.

It's no coincidence that the first bill President Obama signed into law was the Fair Pay Act. Nor was it surprising that one of the president's first public acts was to rescind the Mexico City Policy. Over the past several decades, feminist groups have deeply transformed the political landscape in America -- and, with it, many aspects of our culture. These changes should not be portrayed as exogenous. Indeed, they have played an important role in our cultural evolution, and they should be considered an internal part of our social model.

Unfortunately, I think that many contemporary feminists -- like other kinds of activists -- have a "tendency to minimize victories and exaggerate threats." In some ways this makes sense. Activism necessitates a certain kind of hyperbole. But these exaggerations distort the complex reality.

After multiple waves of feminism, a series of profound policy changes, and decades of intense social criticism, it's not so easy to make blanket statements about how women are really perceived by society.

At the very least, we should acknowledge that the issue of social perceptions is complex and requires quite a bit more qualification today than it did in the past . . . .

Saturday, September 26, 2009

Thank you for calling Air Health Care . . .

This is kind of an interesting perspective, though obviously health care is very different from air travel. Still, it's something to think about.

In fact, this little spoof seems to really get to the heart of David Goldhill's point (here is his brilliant cover piece for the Atlantic Monthly) . . .

The biggest problem with the American health care system is the backward incentives.

Why do we as consumers accept such poor quality? Because we don't see ourselves a customers operating within a market structure. Why don't we see ourselves as customers? Because most of us aren't paying anything like the real cost of our health care.

For Glenn Beck's Purposes

What an idiot . . . .

Thursday, September 24, 2009

A Letter to Andrew Sullivan, Ctd.

Andrew Sullivan posted my second letter questioning the results of this survey. (I previously posted about this here.)

. . . And this is why I love him.

Health Insurance and Entrepreneurship in America

Ezra Klein makes a good point regarding private, non-portable health insurance:

We may just have a culture in which people who care about health-care coverage don't think about becoming entrepreneurs, as they know perfectly well that they can't sacrifice the safety provided by a large employer. You've heard of learned helplessness? This is learned corporatism. A culture in which people didn't worry about health-care costs might also be a culture in which they were more willing to consider occupational risks.

So will health-care reform fix this? It will help. The various health-care plans under consideration all make life better for a would-be entrepreneur who wants to buy health insurance. The subsidies will help him afford coverage. The regulations will make sure insurers can't deny his family outright our jack up their rates. The exchanges will give him purchasing power and choice.

The question is really whether this renewed entrepreneurial spirit could make up for the deadweight loss from government-mandated coverage. Certainly, there are some people who choose not to buy health insurance. Taxing them would mean a loss of efficiency and, potentially, a loss of entrepreneurship. (Though the president denies that an insurance mandate would be equivalent to a tax increase, many economists aren't buying it.)

Ezra seems to be considering only the upside of mandated coverage. But, you may say, opponents of the plan tend to consider only the pitfalls, so can you really blame him?

Well, yes. I try to hold Ezra to a higher standard . . . .

Wednesday, September 23, 2009

A Letter to Andrew Sullivan



I'm not sure you should take the results of this survey at face value (as you seemed to here). The sample size for the poll is 621, and the margin of error is +/- 3.9%. But only 35% of the respondents are Republican. That means that the margin of error for this subgroup is closer to +/- 6.65%. The pollster also notes that "other factors, such as refusal to be interviewed and weighting, may introduce additional error that is more difficult to quantify."

If you look at some of the other cross-tabulations, they're very difficult to believe. For example, according the poll, 22% those between the ages of 18 and 29 believe President Obama is the Anti-Christ. This compared to only 5% of those age 30 to 45; 9% of those age 46 to 65; and 7% of those over the age of 65.

Since when are younger people more predisposed to believe President Obama is the Anti-Christ? This contradicts every polling trend we've seen.

Anyway, I just think it's worth mentioning that conspiratorial thinking may not be as prevalent among Republicans as this poll leads us to believe.


Jeremy Biggs

Tuesday, September 22, 2009

Faulty Health Care Comparisons

I made this point a while back (here and here), but it's worth reiterating.

Different health care outcomes in various countries cannot necessarily be attributed to differences in health care delivery systems.

O'Reilly and the Pubic Option

The title of this post is a little deceptive, since it's not clear whether Bill O'Reilly is actually endorsing a federally-run "public plan" or simply coming out in favor of the insurance exchanges, which his guest seems to consider the same thing.

Either way, this is why I don't think O'Reilly should be lumped into the same category as Sean Hannity, Rush Limbaugh, and other far-right extremists. O'Reilly is rude and obnoxious, and his show is often unwatchable. He's also way too socially conservative for my tastes.

But he's far less ideological than some of his right-wing cohorts. And it's encouraging to see that he has intellectual dexterity to rethink his position on such an important issue.

Monday, September 21, 2009

Moore's Failure

I will not be seeing Michael Moore's latest film, "Capitalism: A love Story." Having suffered though "Roger & Me," I think I have a pretty good idea of how Moore feels about free markets and corporate power. I can almost write the script.

In fact, it seems like CNNMoney beat me to it:

By now, a Michael Moore film is its own genre: a vigorous vaudeville of working-class sob stories, snippets of right-wing power players saying ugly things, longer interviews with experts on the Left, funny old film clips and, at the climax, Moore engaging in some form of populist grandstanding.

The reviews that I've read are largely mixed -- praising Moore as a skilled documentarian, while acknowledging his inability to offer coherent solutions to the "problem" that he identifies ("Capitalism is evil"). I think this has always been Michael Moore's greatest failure as a political pundit.

Erroneous facts and willful contradictions aside, Moore's films are always entertaining and often heart-wrenching. Even when you disagree with the guy, you have to admit that his stunts are pretty funny and he sure knows how to tug at the emotional heartstrings. Sometimes, he even makes a good point.

But while Moore can identify the problems -- and maybe even make those problems appear more "relevant" -- he can never seem to generate any real answers. What does Moore do when international competition pushes American car companies to outsource more jobs? He browbeats the CEO of General Motors. What does he do when a global financial meltdown causes millions of layoffs? He proclaims that "capitalism is evil."

All of this is great for the far-left sycophants who devour every morsel that Moore throws their way, but for those of us actually interested in viable policy solutions to complicated problems, Moore's "Capitalism" isn't quite worth the price of admission. It's easy to point out problems; the challenge is proposing realistic alternatives.

More than anything, Americans need to acknowledge the inherent complexity of our human institutions. It's the only way we can begin the hard task of reform.

Unfortunately, Moore seems content peddling his standard oversimplifications . . . .

Saturday, September 19, 2009

Right-Wing Extremism, Left-Wing Paranoia

A great piece from Reason's Jesse Walker on the paranoia of some center-left pundits (via Andrew Sullivan).

Walker writes:

When critics blamed pro-life partisans for the death of George Tiller, there at least was a coherent connection between the pundits' anti-abortion rhetoric and the assassin's target. Say what you will about Glenn Beck and Rush Limbaugh, but neither is known for railing against the Holocaust museum. If Beck, to borrow Rich's mixed metaphor, is cheering on a kettle, it isn't the kettle that produced James von Brunn.

We've heard ample warnings about extremist paranoia in the months since Barack Obama became president, and we're sure to hear many more throughout his term. But we've heard almost nothing about the paranoia of the political center. When mainstream commentators treat a small group of unconnected crimes as a grand, malevolent movement, they unwittingly echo the very conspiracy theories they denounce. Both brands of connect-the-dots fantasy reflect the tellers' anxieties much more than any order actually emerging in the world.

When such a story is directed at those who oppose the politicians in power, it has an additional effect. The list of dangerous forces that need to be marginalized inevitably expands to include peaceful, legitimate critics.

Friday, September 18, 2009

Polling New Jersey Republicans

I've been reading a lot about polling and survey design lately, so I thought I'd comment on this article from The Huffington Post, which seems a bit misleading.

The author, Rachel Weiner, cites the results of a recent poll of New Jersey residents, which suggest that one-third of New Jersey Republicans do not believe that President Obama was born in the United States. The results also indicate that 14 percent of New Jersey Republicans believe that President Obama is the Anti-Christ.

Let's break this down a bit.

The sample size for the poll was 500, which means that the margin of error is +/- 4.5%. The pollster also notes that "[o]ther factors, such as refusal to be interviewed and weighting, may introduce additional error that is more difficult to quantify." Thus, nonresponse bias may have contributed an even greater degree of uncertainty.

It's important to point out that this was a poll of "likely New Jersey voters." The sample contained only 165 Republicans, putting the margin of error closer to +/- 7.5% for this group. (For those of you who are interested, here is a good margin of error calculator.)

When we begin to break a small sample size down into different subgroups, the results are subject to a significantly higher degree of uncertainty -- in this case, with the additional caveat about nonresponse bias.

Interestingly, The Huffington Post failed to note that, according to this same poll, roughly one-third of New Jersey Democrats believe that President Bush had advance knowledge of the 9/11 terrorist attacks. And 6 percent of Democrats believe that we should eliminate public education as well as the entire federal government.

We need to be very careful how we interpret results like these from polls with such small sample sizes. You can't simply look at the cross-tabulations and assume that the margin of error remains constant. It doesn't.

Wednesday, September 16, 2009

Health Care Cost Savings and the Baucus Plan

Today, the CBO released its preliminary cost estimate [pdf] of the Senate Finance Committee's health care proposal.

The new bill -- which would mandate coverage, but drop the public option -- is expected to reduce the federal deficit by about $49 billion over the next 10 years. This seems like great news. However, CBO Director Doug Elmendorf notes:

These projections assume that the proposals are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate (SGR) mechanism governing Medicare’s payments to physicians has frequently been modified (either through legislation or administrative action) to avoid reductions in those payments. The projected savings for the Chairman’s proposal reflect the cumulative impact of a number of specifications that would constrain payment rates for providers of Medicare services. The long-term budgetary impact could be quite different if those provisions were ultimately changed or not fully implemented. (If those changes arose from future legislation, CBO would estimate their costs when that legislation was being considered by the Congress.)

This is, of course, the same objection that Megan McArdle has made. Greg Mankiw tries to put it into layman's terms:

[T]he plan would reduce the deficit if it were carried out as written, but there is good reason based on historical experience to be skeptical that it would be.

Let me try to put CBO's point in a more familiar setting: Your friend Joe, who says he want to lose weight, asks you for an extra slice of pie after dinner. Naturally, you are doubtful about the wisdom of the request. "Ahem, Joe," you whisper, "Aren't there a lot of calories in that?"

"Yes," he says, "but the pie is part of a larger plan. I am committed not only to eating that slice of pie but also to going to the gym every day for the next week and spending at least half a hour on the treadmill. That exercise will more than work off those extra calories."

"But that's what you said last week, when you asked for piece of cake. And you didn't end up going to the gym."

"Yes, I know" he replies ruefully, "but this time I really mean it . . . . Can you please pass the pie?"

I think this is pretty on-target. Heart-wrenching stories like this not only prevent lawmakers from following through with proposed cost-cutting plans, but often force them to expand benefits and increase funding to health care entitlement programs.

Update: Time Magazine offers this primer on the Baucus health bill.

Monday, September 14, 2009

Cost-Cutting Ideology

Greg Mankiw is skeptical of the president's proposal to add a "provision" to the health care reform bill that "requires us to come forward with more spending cuts if the savings we promised don't materialize."

Meahwhile, Megan McArdle is dismayed by Andrew Sullivan's comment that "no one can argue that what looks like the current healthcare reform would cripple future finances as profoundly as [the Medicare prescription drug benefit]." Megan writes:

In short, it is not only not true that "no one" believes that this will cost more than Medicare Part D, it's not really very reasonable for anyone to disbelieve it. We are, after all, preparing to provide health care for millions of more people, who will not only be consuming prescription drugs, but also heart catheterization and asthma treatment and the leg amputations that doctors apparently prefer to providing routine diabetes care. Prescription drug costs are on the order of 10% of overall spending, even for Medicare.

So, why all the push-back from right-of-center economists?

The idea that the the Obama administration can ensure deficit neutrality by simply adding a cost-saving "provision" to the legislation is a bit too much to swallow. For example, Megan points out that the Medicare "sustainable growth rate" -- which is supposed to keep Medicare spending in line with inflation -- has consistently been adjusted upward by Congress in order to keep doctors from refusing Medicare patients. This has been a big problem, and it's why Medicare has come to occupy an increasingly larger percentage of the federal budget.

I think Megan is also correct about another thing -- there seems to be a growing tendency among some Obama partisans to uncritically accept the administration's talking points as some sort of substitute for reality. This goes beyond mere ideological loyalty.

For example, I was stunned when Ezra Klein -- a normally sensible left-wing political analysts -- actually criticized the CBO when its numbers conflicted with the administration's numbers. I've also seen friends and relatives question the accuracy of this article because they trust the president more than they trust a well-respected, independent fact-check site.

This kind of thing really has to stop. Progressives rightly criticize some of the more ideologically rigid conservative pundits for refusing to acknowledge reality, even when it smacks them in the fact.

They shouldn't be falling into the same trap. The president is not the arbiter of truth.

Update: Andrew responds to Megan, and Megan replies with a rather wonky, long-winded post explaining the complexities of budget scoring.

Update II: Andrew posts a reader response to Megan, and Megan retorts.

Again, I think Megan wins this one. It's true that Medicare Part D isn't quite the same as the health care legislation currently under consideration, but I think this is the salient point:

If any of the cuts or the taxes fails, the deficit starts bigger, and gets bigger faster. Meanwhile, Obama has moved forward one of the really expensive bits, covering people who are uninsurable because they have some expensive disease.

How are we paying for this? Dunno. It's all too vague. But to my ears, Obama has so far failed to rule out anything expensive, like generous subsidies, and also failed to outline who he's going to tax or cut benefits to if he's serious about deficit neutrality. So a mere stated wish to stay deficit neutral just won't do--every president states that sort of wish. The question is, what will they do to get there? Obama's coyness on this topic is reaching it's sell by date. It's time for the president to commit to an actual plan with actual numbers we can check.

Thursday, September 10, 2009

Uninsured in America

Megan notes that the president has "downgraded" the number of uninsured Americans to 30 million -- most likely because the more commonly used statistic (45 million) includes immigrants, who will not have access to public insurance under the new plan.

Depending on how you look at it, the real number of uninsured is probably even lower than 30 million, since many of the uninsured are either eligible for some kind of public health insurance or wealthy enough to purchase coverage on their own.

Wednesday, September 9, 2009

Health Care Speech: The Good and The Bad

I didn't get a chance to watch the president's speech, but I read a pretty lengthy synopsis. From what I gather, Obama did an excellent job selling his proposals and dismantling some of the more transparent lies disseminated by conservative opponents of the bill. (Here is a good roundup of some of those lies.)

If nothing else, Obama definitely deserves credit for trying to put Congress back on track.

And it goes without saying that Congressman Joe Wilson should be ashamed of himself for his awful outburst. Kudos to John McCain for calling Wilson out. Wilson's comment was even more ridiculous because his claim is false. Obama is right. The bills being considered by Congress would not cover illegal immigrants.

Having said that, I do think it's important to address some of the (relatively minor) falsehoods that the president was peddling tonight:

1) Despite what the president says, preventative care is not likely to save money -- in fact, it may end up leading to higher spending overall. I've addressed this point in a previous post.

2) The House bill would allow abortions to be covered under the public plan. The president keeps insisting that this isn't true. He's either fudging or he's genuinely ignorant.

3) It's at best misleading for the president to insist that everyone who is currently covered will be able to 'keep what they have.' The truth is much more complicated and uncertain.

4) As one of Megan McArdle's commenters pointed out, Obama's reference to the highly-concentrated Alabama health insurance market is a bit odd and incoherent. Blue Cross Blue Shield Alabama -- which has come to dominate the market in that state -- is actually a not-for-profit insurance company. Since Obama has repeatedly argued that profit motive is one of the things stifling competition in the industry, the Alabama case seems to undermine his point.

Tuesday, September 8, 2009

Health Care Thought for the Day

It's often said that there are three major problems in American health care reform: cost, availability, and quality.

Unfortunately, I think there is really one major problem: People disagree over the relative importance of each problem.

Cultural Influences on Poverty in America

In his column today, David Brooks points to this article in the recently-launched National Affairs magazine. The author, Ron Haskins, paints a complex picture of poverty and economic inequality in the United States.

Haskins's ultimate conclusion:

[A]lthough there is room for government to help advance the cause of economic mobility in America, it can do so mostly by encouraging personal responsibility. Poverty in America is a function of culture and behavior at least as much as of entrenched injustice, and economic mobility calls not for wealth-transfer programs but for efforts that support and uphold the cultural institutions that have always enabled prosperity: education, work, marriage, and responsible child-rearing.

Thus, the inequality debate is not nearly as relevant to the more important question of mobility as it sometimes seems to many advocates and politicians. Inequality is a cloudy lens through which to understand the problems of poverty and mobility, and it does not point toward solutions. Great wealth is not a social problem; great poverty is. And great wealth neither causes poverty nor can readily alleviate it. Only by properly targeting poverty, and by understanding its social, cultural, and moral dimensions, can well-intentioned policymakers hope to make a dent in American poverty — and thereby advance mobility and sustain the American Dream.

I think one of the problems with contemporary liberalism has been its unwillingness to seriously acknowledge the destructive cultural factors that hinder economic mobility in some low-income communities. Many progressives behave as if "institutional inequality" is the only thing limiting the available opportunities for low-income families. But conservatives rightly point to the importance of personal responsibility and family stability.

Indeed, it often seems as though the liberal "model" of society has failed to account for the vast array of government-sponsored social welfare and social justice programs introduced over the past several decades -- most of which have failed to remedy the problems that they were designed to address.

Unfortunately, we now have a conservative movement that is more interested in browbeating the president over a simple "stay in school" speech than challenging him to more seriously address issues like parental involvement.

Update: Here is a good article explaining why conservatives should've been supporting Obama's speech to school children.

Anecdote of the Day

From John Kingdon's excellent Agendas, Alternatives and Public Policies:

One example of the principle of equity as the driving force [in the policymaking process] is the case of the government's renal dialysis program. As soon as the technology for convenient dialysis was perfected, it became clear that some people were receiving this life-giving treatment and others were not. The selections of patients to receive treatment were made on the basis of ability to pay, qualification for experimental study groups, proximity to the few centers where dialysis was being performed, and the happenstance of personal health insurance coverage. Gripping stories appeared in the popular media about "death committees" of physicians that were charged with deciding whose lives should or should not be saved.

Such a fundamental, dramatic difference of treatment was more than decision-makers could bear. The Senate passed a short rider introduced right on the floor which provided that renal dialysis and kidney transplants be financed by Medicare, and the House quickly followed suit. So compelling was the inequity that had thrust this item onto the agenda that Congress really did not consider the cost of the program in any detail, a cost that exceeded a billion dollars within a few short years. As one knowledgeable respondent summarized the forces that lead to such sudden agenda status and passage, "When there is serious inequity, that is politically and socially unstable. Once a technology is developed, everybody will want it." The moral pressure to avoid letting people die, when a procedure was available to save them but for a cost, was simply irresistible.

Another great example of why the "death panel" protesters are missing the real problem with increased government intervention into the health insurance market . . .

Monday, September 7, 2009

American Health Care Wants

Ross has a really good article in today's NYT on the morality and practicality of physician-assisted suicide. He writes:

There are many good reasons to oppose assisted suicide. It transforms a healing profession into a killing profession. It encourages relatives to see a loved one’s slow death as a problem to be solved, rather than a trial to be accepted. And as Emanuel noted in his 1997 essay, its “beneficiaries” are far more likely to be suffering from psychological distress than unbearable physical pain.

But in the profligate, Promethean United States, it probably won’t lead to rationing-by-euthanasia. It’s just as likely to become one more “intervention” that we insist every health insurance plan should cover — on our way, perhaps, to a rendezvous with fiscal suicide.

I agree with Ross's ultimate conclusion. The furor over government-sponsored "death panels" isn't just silly and distracting -- it's totally missing the point.

The problem with increased government intervention into the American health care system isn't rationing. (In fact, as regular readers of this blog know, I think that some sort of rationing is essential from purely practical point of view.) The problem is that Americans want unlimited care at unlimited expense. We also want unlimited choice, as Ross points out.

In the United States, the number of state mandated benefits has risen steadily over the past few years. (Here is a helpful old post by Tyler Cowen considering the economic implications of state mandated benefits.) We continue to call on our lawmakers to force health insurers to cover more -- not fewer -- medical services.

Americans want to have it all. We want to maintain our high wages. We want to keep our costly fee-for-service insurance plans. We want to be able to choose our medical providers. And we want access to the most expensive, cutting-edge treatments available.

We just want someone else to pay for everything.

Saturday, September 5, 2009

Random Thought for the Day

There are essentially two way of looking at the legislative process:

1) You can belittle it. You can argue that our Senators and representatives are too beholden to constituents, special interests, and public opinion polls to ever effect real, substantive change on big-ticket policy issues. From this perspective, the process is inherently flawed, with an array of backward incentives that discourage intelligent large-scale reforms.

2) You can embrace it. You can choose to see all the bickering, partisan incrementalism -- the messy "consensus-building" -- as reflective of a society with conflicting moral and social priorities, where no one has a monopoly on truth, but where we slowly move toward some kind of positive collective agreement. As Immanuel Kant allegedly put it, "out of the crooked timber of humanity, no straight thing was ever made."

I suppose you could also do both of these things -- or, perhaps, you could see it in a totally different light -- but I think most people tend to fall into one of these two camps. Either you belittle the process or you embrace it.

So, which camp do you think you fall into?

Thursday, September 3, 2009

Brooks on Health Care Reform

David Brooks responds to Gail Collins's questions on the unraveling of the health care reform bill. I really do enjoy "The Conversation." I think that Collins and Brooks balance each other out very well.

Anyway, I think Brooks makes some excellent points. He writes:

Most Republicans say the Democratic bills are radical and socialist. My problem with them is they are modest and timid. The Democrats say the current health care system is dysfunctional, then they preserve and extend it. They don’t touch the fee-for-service system. They don’t touch the employer-based system. They don’t alter the runaway costs.

. . .

The problem is that incremental reform doesn’t work. We have to go back and redo the system. My big takeway from this whole mess is that incremental reform doesn’t work. We have to go back and redo the system. I’ve said it before and I’ve said it again, the Wyden-Bennett approach is the way to go. It has bipartisan support. It is consistent with traditional American values, emphasizing individual choice, not top down control. It reins in costs in the only way acceptable to American voters, through competition not executive fiat. It would liberate us from the employer-based system that is dying anyway.

. . .

Two other random points. First, the political gridlock right now has nothing to do with Republicans. Democratic moderates are now firmly against the public option and I suspect generally against the Obama approach, because it will cost so many of them their jobs. The House is gridlocked, and it is under total Democratic control. The Senate is too, and would be even if Ted Kennedy’s seat were filled tomorrow.

Second, it should be said that most of the special interests are wildly in favor of the Democratic approach. The lobbyists are spending far more to support it than to defeat it. Big pharmaceuticals spend more money on TV ads than John McCain spent in his fall campaign. And despite this avalanche of money the public is still leaning against reform, at least as currently envisioned by the White House and the Congressional leadership. The public isn’t always right, but the majority views are at least worth taking seriously. Especially if you want to win elections.

Wednesday, September 2, 2009

I Got the Rationing Blues . . .

Julian Sanchez writes:

It's one thing to say there's a shared obligation not to let people suffer or die when we know how they could live many years longer, or in much less pain. I find it a whole lot less compelling to suggest that people are entitled to public provision of, say, Tacerva—which . . . was approved to treat pancreatic cancers because it improves survival time by a whopping 12 days at a monthly cost of $3,500.

This, I think, is the basic problem with health care reform. If you were dying from pancreatic cancer and you could pay $3,5000 to extend your life by 12 days, wouldn't you do it? I certainly would. From an individual perspective, this seems like an entirely rational decision. But from a social perspective, does it really make sense?

If we want to consider health care reform, I think we have to begin talking about rationing. Unfortunately, Republicans are only interested in using the idea of rationing as a scare tactic, while most Democrats refuse to even speak the word . . . .

Update: Megan McArdle has a long-winded post on this. I think she's right that it's a bit silly to frame the question this way -- these drugs don't expand everyone's live expectancy by 12 days, rather they extend the average life expectancy by 12 days.

Thus, some people may enjoy a few extra months of life, while others may die sooner because of an adverse reaction to the drugs. The point is that when you're facing death, a chance to prolong your life even by a few days (and possibly a few months) is probably worth it. The possible upside benefits of the treatment far outweigh the potential side-effects. And it's not easy to deny people drugs that could potentially extend their last few days of life.

McArdle writes:

I'm not saying that this is the standard we should adopt. But I actually think that it has a fair amount of emotional resonance, which is why appeals from cancer patients are so effective when they're denied marginal treatments.

I'd say that's true. And I suspect cost becomes less of an issue for these patients as they approach the end of their lives.

Katie Roiphe Clashes With Feminist Bloggers

Katie Roiphe -- who I think it one of the most brilliant opponents of rape-culture feminism around -- defends herself against the absurd criticisms of her recent piece on the joy of motherhood.

Conor Friedersdorf also jumps to Roiphe's defense.

From what I gather, Roiphe's detractors are upset about the subtitle of the article ("Why won't feminists admit the pleasure of infants?") . . . which Roiphe did not select.

I've been a fan of Katie Roiphe for a little while now. She's an excellent writer and thinker. Here is an old piece where Roiphe attacks the alarmist and self-contradictory ideology of rape-culture feminism . . .